Ovarian cancer BBC Health News Ovarian cancer is hard to spot - and as a result it is often advanced by the time diagnosis is made. It is less common than lung or breast cancer, but on average, only 28% of patients are alive five years after they are first diagnosed, so the death toll is high. However, if it is caught early, the chances of cure are higher - and methods of screening women for early signs of the disease are being evaluated. Women whose fertility is at risk from chemotherapy can now take the step of freezing eggs for future use in these circumstances. In addition, the ovary is responsible for the production of key sex hormones, and the effect of surgery can be to prematurely bring on the menopause. Professor Patrick Johnston, an expert in ovarian cancer based at Queen's University in Belfast, said: "It's a significant problem for the female population in the UK. "One of the major problems with ovarian cancer is that it's insidious - it's a difficult tumour to diagnose - which is one of the reasons why the majority of patients are diagnosed at later stages rather than earlier stages." Women with ovarian cancer in its early stages rarely have more than the most subtle symptoms. They may feel swollen or bloated - or suffer a generalised discomfort in the lower abdomen. But these are all symptoms that could easily be caused by something minor. There could be a loss of appetite or weight loss. It is only as a tumour grows and spreads that the symptoms become more pronounced. It may press on neighbouring organs, such as the bowel or bladder, causing either constipation or frequent urination. There can also be a build-up of fluid in the abdominal cavity, and around the lungs, causing shortness of breath. It is infrequent that an obvious symptom such as bleeding from the vagina is present. A doctor examining for the signs of ovarian cancer will carry out a full pelvic examination, feeling for the presence of a pronounced tumour. Other tests include: ultrasound CT scan barium enema - the patient is given a mildly radioactive enema then a series of x-rays. The barium helps the radiologist highlight the exact shape of the bowel and rectum, which may show up problems There may also be a CT scan carried out to look for signs of cancer. In addition, blood tests may show up the presence of a substance produced by ovarian cancer cells but not by healthy ones. However, the only way to confirm the presence of ovarian cancer is by performing a biopsy operation to take a tissue sample. This is normally done by inserting a needle or tube into the abdominal cavity to take a tiny sample of tumour tissue. Scientists do not yet know what causes ovarian cancer, although there are some clues to its origin. If a woman has a close relative who has had the disease, the risk of her developing the disease increases. Some of these women may currently be offered screening tests, such as blood tests or ultrasound, to try to catch the disease early. Women who have never had a child also run an increased risk of ovarian cancer. Most ovarian cancers happen in women over the age of 50 - the risk increases for older women. In addition, women who have previously suffered from breast cancer are twice as likely to get ovarian cancer in the future. Surgery is almost always the first treatment a woman with ovarian cancer undergoes. This normally involves removal of the ovaries, the womb and the fallopian tubes, which link the two. Usually both ovaries are removed, unless the patient has only a slow growing cancer in one, and wants her fertility to be preserved. The surgeon cannot always be sure that all the cancerous cells have been removed, so chemotherapy is almost always given as well, to kill any which remain in the body. The recommended type of chemotherapy involves drugs called taxanes, which are not available on the NHS in all parts of the country. Radiotherapy is also occasionally used to kill cancer cells in the pelvic area. Many factors increase or reduce the woman's chance of beating ovarian cancer. The main one is the spread of the disease - if caught early, as with many cancers, it is much more treatable, particularly if only one part of one ovary is involved. If the cancer involves a whole ovary, both ovaries, or has spread to involve other tissues, the chances of cure fall. Also important is the type of ovarian cancer - some affect the cells which line the womb, whereas some affect the cells which produce eggs. Both have different cure rates. The woman's age and general state of health can affect her ability to cope with surgery, chemotherapy and other treatments.